“冷”/“热”执行功能缺陷影响ADHD儿童核心症状的作用机制

doi:10.3724/SP.J.1042.2023.02106

摘要/Abstract

摘要：

注意缺陷多动障碍(ADHD)是一种以注意缺陷和(或)多动、冲动为核心症状的神经发育障碍, 与前额叶发育异常所致的执行功能缺陷密切相关。基于此, 从神经−认知−行为的发展途径提出执行功能缺陷可能是认知层面上导致ADHD核心症状的发病机理, 其中与背侧前额叶相关的“冷”执行功能缺陷可能是导致注意缺陷核心症状的主导因素, 而与腹内侧前额叶相关的“热”执行功能缺陷可能是导致多动、冲动核心症状的主导因素。一方面, “冷”执行功能缺陷主要引起工作记忆表征维持失败、抑制控制能力不足、认知转换困难等方面, 这些缺陷进一步导致了个体在注意持续、注意选择和注意转移上受到限制; 另一方面, “热”执行功能缺陷则带来厌恶延迟、奖赏加工异常、动机失调等问题, 使得个体行为抑制失败, 更容易做出冲动性选择, 从而表现出多动、冲动等核心症状。未来研究应进一步检验和完善“冷”、“热”执行功能缺陷影响ADHD核心症状的理论模型以及从认知神经层面上提供更多的实证证据, 同时还需从生态层面考察“冷”和“热”执行功能缺陷对ADHD核心症状的交互影响, 并基于执行功能开发对ADHD核心症状具有个性化、精准化、长效化的干预方案。

关键词: 注意缺陷多动障碍, 执行功能缺陷, 核心症状, 前额叶皮层, 作用机制

Abstract:

Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder characterized by inattention and/or hyperactivity-impulsivity, which is closely related to the executive function deficits resulting from the dysplastic of prefrontal cortex. However the underlying psychological mechanisms behind neurological abnormalities leading to core symptoms in children with ADHD remain unclear, particularly how executive function deficits, which are related to abnormal prefrontal development as the underlying cognitive deficit and endophenotype, influence the emergence of core symptoms of ADHD. To address this scientific question about why and how executive function affect the two core symptoms of ADHD, the following aspects are analyzed and discussed. Firstly, based on the neuro - cognitive - behavioral developmental path, it can be inferred that executive function deficits may be the pathogenesis of the core symptoms of ADHD at the cognitive level and act as a cognitive bridge connecting neuro-developmental abnormalities to the core symptoms. Secondly, executive function can be divided into two distinct components: “cold” and “hot”, which may be the two cognitive pathways leading to different core symptoms of ADHD. And these deficits can result in different behavioral manifestations and have diverse effects on developmental outcome. Among that, the “cool” executive function deficits rooted in the dorsal prefrontal cortex might be the dominant factor affecting inattention symptoms, while the “hot” executive function deficits linked to the ventromedial prefrontal cortex might be emerge as the primary contributor to the symptom of hyperactivity and impulsivity. Building upon this understanding, the present study combines empirical and theoretical evidence to investigate the specific mechanisms through which deficits in the subcomponents of “cold” and “hot” executive function influence the two core symptoms of ADHD. And a graph is presented to illustrate the relationships between the abnormal behavioral manifestations and key executive function deficits observed in children with ADHD under these two core symptom categories. Specifically, on the one hand, the deficits in “cool” executive function mainly results in failures in working memory representation, lack of inhibitory control, and difficulties in cognitive flexibility, and further lead to limitations in attention maintenance, selection, and switching. On the other hand, the deficits in “hot” executive function bring problems like delay aversion, reward abnormality and motivation disorders, which make one fail to inhibit behavior and more likely to make impulsive decision, thereby displaying more symptoms of hyperactivity or impulsivity. In addition to elaborating the specific mechanisms of action of executive function deficits affecting core symptoms of ADHD from the perspective of cognitive and neural correlations, further empirical evidence is provided to support and refine the mechanisms from the perspective of causal manipulation of cognitive interventions and neuroregulatory techniques. Finally, future studies are expected to examine and improve the theoretical model of “cold” and “hot” executive function deficits affecting the core symptoms of ADHD, and provide more empirical evidence at the cognitive neural level. Meanwhile, future studies need to examine this influence the mechanism mentioned above in ecological backgrounds, and further develop intervention projects with personalization, precision and long-acting to alleviate the core symptoms of ADHD based on executive function. To sum up, examining the impact and mechanisms of “cold” and “hot” executive function deficit on the two core symptoms of ADHD children from the perspectives of neuroscience, cognition, and behavior is of great scientific value and practical significance. This exploration offers evidence at the cognitive and neuroscience levels, enabling a deep understanding of the pathogenesis of ADHD. Additionally, it provides an evidence-based foundation for individualized interventions and precise treatments for children with ADHD by examining the effectiveness of interventions through causal manipulation of cognitive interventions and neuroregulatory techniques.

Key words: Attention-deficit/hyperactivity disorder, executive function deficit, core symptom, prefrontal cortex, mechanism

中图分类号:

B845

王雪珂, 冯廷勇. (2023). “冷”/“热”执行功能缺陷影响ADHD儿童核心症状的作用机制. 心理科学进展 , 31(11), 2106-2128.

WANG Xueke, FENG Tingyong. (2023). The mechanism of “cool”/“hot” executive function deficit acting on the core symptoms of ADHD children. Advances in Psychological Science, 31(11), 2106-2128.

图/表 3

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ADHD核心症状表现(DSM-5)		具体问题	主要能力缺陷
注意力缺陷	在学习、做事或者游戏活动时, 难以保持注意力集中	注意力不集中	反应抑制不足、中央执行系统失败	冷执行功能
	逃避、讨厌或勉强参加那些需要保持精神集中的事情
	与他说话时, 心不在焉, 似听非听
	常粗心大意、马虎、不注意细节	注意易受干扰	冲突控制不足
	经常容易因无关刺激而分心	注意易受干扰	冲突控制不足
	很难按照指令与要求行事(例开始启动某个任务后很快离开主题, 转而去做另一件事)	注意难转移	认知转换困难
	难以组织好分配给他的任务或难以完成两项及以上任务	注意难转移	认知转换困难
	经常丢失一些学习、活动中所需要的东西	注意广度缩小	工作记忆表征失败
	在日常生活中会忘事	注意广度缩小	工作记忆表征失败
多动 / 冲动	手脚动个不停, 或在座位上扭来扭去	难以抑制行为	行为控制失败	热执行功能
	在教室或其他必须坐着的场合, 会随意离开座位
	不能安静的玩耍或参加课外活动
	在不该动的场合过分地跑来跑去	过度的活动	感觉加工失调、精力过剩
	一刻不停地活动, 像装了马达一样	过度的活动	感觉加工失调、精力过剩
	在问题还没问完就着急回答	追求及时奖赏	延迟满足较差、奖赏加工异常
	难以等待和轮流排队
	打断别人说话或干扰别人活动
	讲话过多
	「补充」明显的攻击行为	情绪失调	情绪冲动性、情绪调节困难
	「补充」易怒或很容易被别人激怒;
	「补充」难以应对挫折, 容易产生消极情绪

ADHD核心症状表现(DSM-5)		具体问题	主要能力缺陷
注意力缺陷	在学习、做事或者游戏活动时, 难以保持注意力集中	注意力不集中	反应抑制不足、中央执行系统失败	冷执行功能
	逃避、讨厌或勉强参加那些需要保持精神集中的事情
	与他说话时, 心不在焉, 似听非听
	常粗心大意、马虎、不注意细节	注意易受干扰	冲突控制不足
	经常容易因无关刺激而分心	注意易受干扰	冲突控制不足
	很难按照指令与要求行事(例开始启动某个任务后很快离开主题, 转而去做另一件事)	注意难转移	认知转换困难
	难以组织好分配给他的任务或难以完成两项及以上任务	注意难转移	认知转换困难
	经常丢失一些学习、活动中所需要的东西	注意广度缩小	工作记忆表征失败
	在日常生活中会忘事	注意广度缩小	工作记忆表征失败
多动 / 冲动	手脚动个不停, 或在座位上扭来扭去	难以抑制行为	行为控制失败	热执行功能
	在教室或其他必须坐着的场合, 会随意离开座位
	不能安静的玩耍或参加课外活动
	在不该动的场合过分地跑来跑去	过度的活动	感觉加工失调、精力过剩
	一刻不停地活动, 像装了马达一样	过度的活动	感觉加工失调、精力过剩
	在问题还没问完就着急回答	追求及时奖赏	延迟满足较差、奖赏加工异常
	难以等待和轮流排队
	打断别人说话或干扰别人活动
	讲话过多
	「补充」明显的攻击行为	情绪失调	情绪冲动性、情绪调节困难
	「补充」易怒或很容易被别人激怒;
	「补充」难以应对挫折, 容易产生消极情绪